
     POW! for PowerBASIC 3.0 Registration Form 
     -----------------------------------------


___  Yes!  I would like to register POW! for
     PowerBASIC 3.0.  Enclosed is my check or
     money order for $34.95 ($29.95 + $5 S/H).
     Please send me the latest version on disk
     in the format specified below.  I understand
     that I will receive complete source code for
     POW! and free technical support by mail.

     Foreign Users:  Check/M.O. drawn on a U.S. bank
                     or U.S. dollars in cash only please.


___  I do not want to register the POW! library,
     because of the reasons detailed below.  Please
     make the improvements/bug fixes I have specified
     and I will reconsider registering.


Name:  ____________________________  Date:  _________

Address: ____________________________________________
         ____________________________________________

City:    _____________________  State:  _____________

Zip:     ________-_____  Phone: (_____) ____-________


Disk Format: ___ 3 1/2" 1.44MB   ___ 5 1/4" 1.2MB

             ___ Other format not listed: ___________


              _______________________________________

Area for      _______________________________________

Suggestions,  _______________________________________

Comments,     _______________________________________

Bug Fixes,    _______________________________________

Other...      _______________________________________
              
              _______________________________________
              

Mail to:  Tim Gerchmez
          12648 S.E. 81st Pl.
          Renton, WA  98056-9121

Thanks for your registration!

